Cluster Headache: A Quick Overview

Cluster headache is one of the most underdiagnosed and frequently misinterpreted headache disorders due to its distinctive pattern of attacks and symptoms. Migraines, sinusitis, and allergy headaches are well known among patients and healthcare providers, but identifying cluster headaches still remains a challenge due to lack of awareness. Though these headaches are considered rare in comparison to other types, they can have a significant impact on a person’s quality of life; it has been colloquially termed as “suicide headache” because the intensity of pain during attacks can become unbearable enough to push one towards suicidal ideation.

Features Of An Attack

Unlike migraines, cluster headaches usually occur suddenly without the typical aura seen in migraine attacks. It typically follows a circadian pattern, occurring around the same time of the day lasting from 15 minutes to 3 hours. Patients more commonly experience increased attacks during the seasons of autumn and spring or equinoxes, although they might occur year-round without a cutback. Attacks may occur several times a day and hence the term ‘cluster’ was used descriptively indicating repeated bouts which can last from weeks to months or last through a year/years, with or without a period of dormancy.

People may suffer from sleep deprivation as the intensity of pain can keep them up at night. A classic feature of this headache is one-sided pain around or behind the eye with additional symptoms like teary eye, runny nose, drooping eyelids, or nasal congestion on the affected side. The nature of pain is piercing and unbearable, often accompanied by restlessness and agitation.

Reasons and Risk Factors

Headache is often triggered when the nerve (Trigeminal nerve) connected to pain activation centers in the brain is stimulated. The stimulation may be caused by external factors such as smoking, alcohol, or illicit substance use. Besides these factors, people of a certain race may have a susceptibility to developing cluster headaches. A study reported that African American women developed an attack more commonly compared to men of the same race. Also, patients report or get diagnosed with this condition during their early thirties and above.

Traumatic brain injuries resulting from sports, fall, or accidents may also be a risk factor in developing this condition. However, they are not always necessarily related; a study of 553 patients revealed that 26 patients diagnosed with Cluster headache had a history of traumatic brain injury. Strong odors like petroleum, nail polish, or nitrate containing foods may trigger an attack in some individuals. Some studies have even injected subjects (intravenously) with nitroglycerin to induce cluster headaches in order to study the course of the disorder and its management.

What You Need To Know

Experience wise, cluster headaches may occur remarkably similar to migraine attacks unless we cautiously observe the patterns and nature of pain. In some cases, the course of the disease may change with age, and the pattern may become more episodic, making it difficult to diagnose. A survey about Cluster headache in the US revealed that there could be a delay in diagnosis of the condition for even up to 5 years from the onset of the attack. One must bear in mind that one-sided pain that lasts less than 4 hours following a circadian cycle can possibly be indicative of this condition. With adequate and accurate information on the nature of attacks, your doctor can further help you identify typical symptoms and triggers and provide you with appropriate treatment/prevention medication.

References

1.       San-Juan, D., Velez-Jimenez, K., Hoffmann, J., Martínez-Mayorga, A. P., Melo-Carrillo, A., Rodríguez-Leyva, I., García, S., Collado-Ortiz, M. Á., Chiquete, E., Gudiño-Castelazo, M., Juárez-Jimenez, H., Martínez-Gurrola, M., Marfil, A., Nader-Kawachi, J. A., Uribe-Jaimes, P. D., Darío-Vargas, R., & Villareal-Careaga, J. (2024). Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment. Frontiers in Pain Research, 5, 1373528. https://doi.org/10.3389/fpain.2024.1373528

2.       Hoseinnezhad, M., Khazaneha, M., Arvan, H., & Togha, M. (2026). Overview and research Trends on cluster headache Disease: A bibliometric and natural language processing approach. Acta Neurologica Scandinavica, 2026(1). https://doi.org/10.1155/ane/5110463

3.       Goadsby, P., Wei, D., & Ong, J. Y. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 21(5), 3. https://doi.org/10.4103/aian.aian_349_17

4.     Kasper, D. L., Braunwald, E., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & McGraw-Hill Medical Publishing Division. (2005). HARRISON’S Manual of Medicine. McGraw-Hill. https://www.stikesmuwsb.ac.id/wp-content/uploads/2022/11/Harrisons.Manual.of_.Medicine.16th.Edition.pdf

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